Curs 14 farmacoterapie
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Transcript of Curs 14 farmacoterapie
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PARTICULARITI
FARMACOLOGICE N UNELESTRI PATOLOGICE
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PARTICULARITI FARMACOLOGICE NPATOLOGIA CARDIOVASCULAR
Modificareahemodinamic
Conecin!efarmacodinamice
E"em#$e demedicamen%e
Re#erc&ri&nic$inice
Scderea perfuzieitisulare
Scderea Vd, cretereaconcentraiei sanguine
Lidocain,procainamid
Risc desupradozare
Scderea fluxuluisanguin la nivelulmucoasei gastro-intestinale i ale
esutului s.c. i m.
Micorarea asorieidigestive i de la loculin!ectrii
Lanatozida ",digoxina,procainamida
Micorareaiodisponiilitii
"reterea fluxuluisanguin la nivelulmiocardului i creierului
"oncentraii crescute #nmiocard i creier
Lidocain,procainamid,digoxina
Risc crescut dereacii toxicemiocardice ineurologice
Scderea fluxuluisanguin #n ficat
Scderea clearance-ului $epatic
Lidocain,procainamid,teofilin
Risc deacumulare, cufenomene toxice
Scderea fluxuluisanguin renal
Scderea clearance-ului renal
%rocainamid,digoxina
Risc deacumulare, cu
fenomene toxice
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PARTICULARITI FARMACOLOGICE NPATOLOGIA CARDIOVASCULAR
Modificareafi'io#a%o$o(ic
Conecin!efarmacodinamice
E"em#$e demedicamen%e
Re#erc&ri&nic$inice
&eficit de pompcardiac
&eprimaremiocardic
%ropranolol,c$inidin,verapamil,anestezice gen.
&eclanarea sauagravareainsuficieneicardiace i $'(
)iperexcitailitatecardiac
*avorizareaaritmiilor ectopice
&igitalice,simpatomimetice,levodopa, cofein
(ritmii ectopice
"oronaropatie *avorizareaisc$emiei cardiace
Simpatomimetice,cofeina
&urerianginoase,declanarea +M
&ezec$ilireelectrolitice,$ipoaliemie
*avorizareaaritmiilor ectopice digitalice (ritmii ectopice
Stri de retenie$idrosalin
*avorizareareteniei $idrosaline
lucocorticoizi,fenilutazon
deme,agravareainsuficienei
cardiace, )'(
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Modificri fiziop!o"i#ic$ " crdici cr$ po!i%f"&$%' r$c!i(i!!$ !i)&"r " &%$"$
*$dic*$%!$+,D$fici! " po*p$i crdic$,Miocrd "!$r! c& -ip$r$.ci!/i"i!!$
,T&"/&rri d$ co%d&c$r$ 0% *iocrd, Coro%rop!i$ c& $c-i"i/r& pr$cr 0%!r$ por!&" 1ico%)&*&" d$ o.i#$% " %i($"&" *iocrd&"&i
, D$z$c-i"i/r$ $"$c!ro"i!ic$2 -ipo3"i$*i$
, S!ri d$ r$!$%'i$ -idro)"i%
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PARTICULARITI FARMACOLOGICE NINSUFICIENA RENAL
% i%)&fici$%' r$%",Scd$ cpci!!$ d$ "$#r$ "/&*i%$i p")*!ic$ c&
cr$1!$r$ propor'i$ for*$i "i/$r$ r$)po%)/i" d$
*ri*$ $f$c!&"&i fr*co"o#ic 4/r/i!&ric$5,Scd$ *$!/o"izr$ c& c&*&"r$ *$dic*$%!$"or
1i cr$1!$r$ ri)c&"&i d$ RA 4PAS2 izo%izid5
,Scd$ $"i*i%r$ r$%" *$dic*$%!$"or $p&r!$pr$po%d$r$%! r$%" pri% fi"!rr$ #"o*$r&"r c& IT *ic, 6&)!r$ doz$i 1i i%!$r("&"&i di%!r$ doz$ 4A7*i%o#"icozidic$2 c$f"o)pori%$2 di#o.i%5
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Modificareafi'io#a%o$o(ic
Conecin!efarmaco$o(ice )i
%o"ico$o(ice
E"em#$e demedicamen%e
Re#erc&ri&nic$inice
Scderea reactivitiitisulare
Scderea activitiifarmacodinamice
(tropin,vasopresin,insulin
+neficienterapeutic
"reterea reactivitii
tisulare
"reterea activitii
farmacodinamice
(ndrogeni,
deprimantecentrale
Rspuns
eritropoieticcrescut
'ulurri electrolitice Modificareareactivitiifarmacodinamice
&igitalice Risc crescut dereacii toxice
Leziuni renale "reterea toxicitiirenale
(/aminoglicozidice
0efrotoxicitate
Modificri tisulareextrarenale carefavorizeaz reaciitoxice
"reterea toxicitii (/aminoglicozidice(nticoa$ulante
(ntidiaetice
1totoxicitate
Risc de$emoragii
)ipoglicemie
MODIFICRI FI8OPATOLOGICE N INSUFICIENA RENAL CARE POTINFLUENA PROFILUL F9DINAMIC :I F9TO;ICOLOGIC AL MEDICAMENTELOR
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PARTICULARITI FARMACOLOGICE NAFECIUNILE TRACTULUI DIGESTIV
Tr%zi! cc$"$r!,Di*i%& /)or/'i 4/&!i")copo"*i%2 for*$"$
$%!$ro)o"&/i"$2 pr$pr!$"$ r$!rd5 Si%dro*$ o/)!r&c!i($
,Cr$1!$ c%!i!!$ d$ )&/)!%' di)po%i/i" p$%!r&/)or/'i$ Si%dro**$ d$ *"/)or/'i$ i%!$)!i%"
,S!$!or$$ , )cd$ /)or/'i C2 F$2 (i!*i%$
E)of#i! d$ r$f"&. , )&%! CI %!ico"i%$r#ic$"$ Co%)!ip'i , )&%! CI pr)i*p!o"i!ic$"$ Co"i! &"c$ro) , )&%! CI *$dic*$%!$"$
iri!%!$
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PARTICULARITI FARMACOLOGICE NAFECIUNILE
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